Psychiatrist Is a specialist with a medical degree who deals with the treatment of mental disorders. Mental disorder is a group of symptoms and behavioral changes caused by mental disorders and causing mental distress in a person.

All specialists, in the name of whose profession there is a particle of "psycho", are engaged in the study and elimination of mental disharmony. From the point of view of psychiatrists, the brain is responsible for the mental balance of a person, however, unlike neurologists, psychiatrists look at the brain not as an organ with its own departments that regulate other organs, but as an analyzer of reality.

The branch of medicine that a psychiatrist studies is called "Psychiatry", which is translated from Greek as "healing the soul" ( psyche - soul, iatreia - treatment). This area of ​​medicine is common to psychiatrist and psychotherapist. However, the psychotherapist deals with those problems that can be solved with the help of psychotherapy - one of the directions in the treatment of mental disorders ( includes non-drug methods).

They turn to a psychotherapist in cases where the patient is fully aware of his condition as a violation and can consciously control it. The psychiatrist, on the other hand, deals with the treatment of severe mental disorders that are dangerous for both the patient and the people around him and require the use of medications.

It is important to know that a psychiatrist can be a psychotherapist at the same time, that is, apply the methods of psychotherapy in the treatment of diseases.

There are two more specialists who deal with the human psyche - a psychoanalyst and a psychologist. They differ from a psychiatrist and a psychotherapist, first of all, in that they have a higher humanitarian education ( psychological, less often - pedagogical), that is, they are not doctors. The psychoanalyst uses psychoanalysis as a method of treatment, that is, he "heals with words", talking with a person and analyzing the causes of mental disorders. The psychologist, on the other hand, examines the problems in relationships between people, teaches communication with oneself and with the world around him.

Among psychiatrists, you can find the following narrow specialists:

• psychiatrist-narcologist- a doctor treating patients with drug addiction, alcoholism and substance abuse ( all types of addiction are manifested by one or another mental disorder);
• child psychiatrist- deals with deviations in mental development and other disorders in children ( eg autism);
• adolescent psychiatrist- treats mental problems that arise or begin to manifest in adolescence;
• psychiatrist-gerontologist- deals with mental disorders in the elderly;
• forensic psychiatrist- studies the mental state of people who have committed a crime;
• suicidal psychiatrist- works with patients who have a tendency to commit suicide or have thoughts about it;
• psychiatrist-somnologist- deals with mental disorders, which are manifested by sleep disturbances;
• neuropsychiatrist- a neurologist who treats brain diseases that cause mental disorders;
• epileptologist Is a psychiatrist or neurologist who studies in depth, diagnoses, and treats epilepsy.

The psychiatrist works in the following institutions:

• psychiatric clinics;
• neuropsychiatric dispensaries;
• narcological dispensaries;
• polyclinics;
• research centers.

What does a psychiatrist do?

The psychiatrist is engaged in the identification, treatment and prevention of mental disorders. The psyche is the property of the brain to reflect reality or reality, that is, the ability of a person to pass everything that happens around him through his emotions and consciousness. Through mental perception, a person interacts with the outside world. If interaction with the world is disturbed, then mental disorders arise. At the same time, some congenital and hereditary conditions ( dementia, personality disorders) do not give the opportunity to fully interact with the world around a person.

The psyche is made up of the following processes:

• cognition- the ability to perceive the world around us ( using sight, hearing, smell, taste and touch), think and remember;
• emotions- attitude to the surrounding world and what is happening around;
• volitional processes- include human desires, facial expressions, attention and other processes that make up human behavior.

Currently, psychiatry uses the term “mental disorder” instead of the terms “disease” and “disease”. The disease status was retained by those pathologies that are most studied and develop as a result of structural changes in the organ that is responsible for the human psyche, that is, in the brain ( doctors call such pathologies organic).

In the English language literature, mental disorder is referred to as "mental disorder" - a mental disorder, and "mental" means "produced in the mind." Thus, it turns out that in the West, mental disorder is equated with a disorder of mental activity, and not mental balance. However, the mind is a purely intellectual concept, and the soul is a philosophical one. That is why, when mental activity is disturbed, it is difficult to explain what exactly and where it hurts, ( they used to say that a person lost his mind or that a person “has a pain in his soul”).

Psychiatrists classify mental disorders according to their type, that is, take into account their depth, relationship with stress, the degree of personality disorder, behavior change and the ability to live in society.

All mental disorders can be classified into the following three groups:

• Borderline Disorders- neuroses and personality disorders. Under these conditions, a person is able to live normally in society, he does not lose self-awareness, that is, the ability to assess himself and his condition, and the cause of such disorders is associated with stress, and the symptoms are weak.
• Psychotic disorders- includes three severe and most well-studied mental pathologies, namely schizophrenia, epilepsy and mood disorders. These diseases disrupt a person's ability to evaluate himself, to control his behavior, while a person becomes dangerous to society if his work is connected with the lives of other people. Such disorders are little dependent on stress, and the symptoms are pronounced and distinct.
• Dementia ( dementia) and mental retardation ( mental retardation) - disorders that are characterized by the inability of a person to learn new things or the loss of this ability, while social adaptation is impaired. Stress is not the cause of these disorders, the main role belongs to structural damage to the brain or its congenital ( genetically determined) underdevelopment.

Borderline disorders are dealt with by both psychiatrists and psychotherapists, psychotic disorders by psychiatrists, and dementia and oligophrenia by psychiatrists and neuropathologists ( psychoneurologists).

The responsibilities of a psychiatrist include:

• identification of persons with mental disabilities;
• identification of healthy individuals who have risk factors for the development of mental disorders;
• accurate diagnosis of mental disorder and identification of its cause;
• the appointment of treatment, management and rehabilitation of patients with mental disorders;
• medical examination ( assessment of legal capacity and mental health);
• preventive examinations of certain groups of the population ( students, elderly people working in production with hazardous substances, military);
• hospitalization of especially critical patients ( voluntarily or compulsorily).

A psychiatrist treats the following mental disorders:

• neurotic disorders ( neurosis);
• psychopathy ( personality disorder);
• psychomotor disorders;
• darkening of consciousness;
• memory impairment;
• schizophrenia;
• epilepsy;
• mood disorders ( mania, depression);
• manic-depressive syndrome;
• cyclothymia;
• dementia ( dementia);
• oligophrenia ( mental underdevelopment);
• autism;
• sleep disturbance.

The psychiatrist also deals with mental disorders in the following diseases:

• diseases of internal organs ( somatic diseases);
• alcoholism;
• drug addiction and substance abuse;
• infectious diseases;
• a brain infection;
• intoxication with drugs or industrial poisons;
• traumatic brain injury;
• brain tumors.

Neurosis ( neurotic disorders)

Neuroses ( psychogenic diseases, psychogenias) Is a group of mental disorders in which the brain is not structurally affected, but functions in a state of excitement due to the fact that the psyche cannot adapt to new conditions of interaction with the outside world. Symptoms of neurotic disorders resemble those of fever ( sweating, trembling, palpitations and other manifestations) or in case of a disorder of the function of any organ ( diarrhea, arrhythmias, visual impairment and more).

The neurosis has the following main criteria:

• begins under the influence of mental trauma;
• manifests itself as vegetative symptoms ( dysfunction of internal organs);
• the disappearance of symptoms in the elimination of psychotrauma.

In general, neurotic disorders are within the scope of the psychotherapist rather than the psychiatrist, although the latter can also treat them in severe mental disorders.

The following syndromes belong to neurosis:

• obsessive-compulsive disorder- anxiety-phobic syndrome, obsessive-convulsive syndrome, panic syndrome;
• hysterical syndromes- seizures, disorders of sensation and pain ( senestopathies), speech disorders ( stuttering) and symptoms arising from diseases of internal organs.

Psychosis

Psychosis is the inability to distinguish reality from sensations that seem real ( this is the main difference between psychosis and neurosis). Psychosis is not an independent disease; it is part of the manifestations of other mental disorders.

With psychosis, the patient has the following characteristic phenomena:

• hallucinations- the feeling of something that does not exist in reality ( sounds, images and so on);
• rave- incorrect conclusions and reasoning of the patient, in which he believes.

Psychomotor disorders

Psychomotor disorders are movement disorders that are caused by an agitated or depressed psyche.

Psychomotor disorders include:

• hypokinesia- slowing down of movements or their small number;
• stupor- immobility, which is manifested by the absence of movements, thoughts and speech, while all these functions are not lost;
• catatonia - muscle spasms and various active movements of the patient, which are often involuntary, look unnatural and occur against the background of mental overexcitation;
• seizure - an attack of loss of consciousness with convulsions.

Schizophrenia

Schizophrenia is a chronic mental disorder ( psychosis), at which its split occurs, that is, the connection between different functions of the psyche is broken. In this case, the patient's personality changes, he becomes aggressive, pathologically closed ( autism), almost devoid of emotion, at the same time, hallucinations and delusions appear.

Autism

Autism is a mental disorder that manifests itself before the age of 3. Autism can occur with various mental pathologies, with psychiatrists treating each syndrome separately.

Autism is characterized by the following manifestations:

• restriction of communication- violation of the processes of communication with other people, patients avoid eye contact, touch;
• stereotyped movements- constantly repeated aimless movements of various parts of the body;
• tendency to uniformity- the patient arranges objects in a strictly defined way, resists any changes in things familiar to him;
• limitation of interests- the interests of the patient can be limited to only one occupation ( the same game or music);
• autoaggression- the actions of the patient are dangerous for him, for example, the child may bite himself;
• low intelligence- changes in intelligence can be expressed to varying degrees.

Epilepsy

Epilepsy is a chronic disease of the brain in which spontaneous, that is, unprovoked, seizures are observed. However, having a seizure is not necessarily epilepsy, just like having an epileptic seizure is not necessarily a seizure. Epilepsy can manifest itself in other ways, such as muscle twitching, smacking, visual hallucinations, behavioral changes, and unintelligible, unconscious behavior.

Due to the variety of symptoms and frequent disputes between psychiatrists and neurologists about who should treat epilepsy, epileptologists have arisen who deal specifically with epilepsy. An epileptologist can be either a psychiatrist or a neurologist. It is important that this specialist is well versed in both psychiatry and neurology.

Personality disorder ( psychopathies)

Psychopathy is a mental pathology in which a person's personality disorder occurs and a disharmonious character is formed.

Psychopathy is not considered a disease, it is a congenital underdevelopment of the psyche, which does not know how to do something, for example, to sympathize, take offense or forgive, while a person is practically unable to learn this.

The so-called accentuated personalities differ from psychopathies, in which the character of a person has a pathological orientation ( accent), but this is not a disorder, it can be eliminated by education or self-education. If the expressed personality disorder is acquired in nature, then this condition is referred to as psychogenic personality development.

Affective disorders

Affect is an emotional reaction that is poorly controlled and is reflected in a person's behavior, in contrast to mood, which can be hidden and behave inappropriately. Affective mood disorders are a violation of a person's emotional state in the form of a pathological, inadequately strong reaction, or, conversely, in the form of a lack of reaction to an event.

Depression

Depression is a syndrome that belongs to mood disorders and is caused by depression of mental activity.

Depression is characterized by a combination of the following three symptoms:

• yearning;
• slow pace of thinking ( lethargy);
• slowdown and decrease in physical activity.

Manic syndrome

Manic syndrome - this is the exact opposite of depression, arises from the overexcitation of the psyche.

The following symptoms are characteristic of the manic syndrome:

• inadequate and overly good mood;
• fast speech and active gestures;
• quick switching of thoughts according to the associations that have arisen;
• the tendency to overestimate their capabilities ( megalomania");
• the desire for active, extreme, often life-threatening actions.

Manic-depressive psychosis or bipolar disorder is a syndrome characterized by alternating periods of depression and mania.

Cyclothymia

Cyclothymia ( Cyclos - circle, thymos - soul) Is a mild form of manic-depressive psychosis.

Memory impairment

Memory is the ability to accumulate, store and reproduce received information. By itself, memory impairment is only a symptom that can be combined with other mental disorders ( schizophrenia, epilepsy, neurosis, psychosis).

Memory impairment can manifest itself:

• spontaneous influx of memories ( hypermnesia);
• memory impairment ( hypomnesia);
• loss of individual fragments from memory ( amnesia);
• distortion of existing memories ( paramnesia).

Clouding of consciousness

Consciousness is the ability of the psyche to concentrate attention, orient itself in time and space, and also be aware of its "I". A person in a clear consciousness can correctly answer the questions "who are you?", "Where are you?", "What is the date today?" The more objectively the psyche reflects reality, the clearer the person's consciousness.

Clouding of consciousness can manifest itself in the following syndromes:

• delirium ( rave) - violation of orientation in time and place, while delusions and hallucinations occur, the patient experiences anxiety or fear;
• oneiroid ( dream) - the patient has a double orientation in time, space and his own personality, he is delusional, telling fantastic things, experiencing delight from hallucinations;
• amentia ( madness) - the patient is completely disoriented in space, in time and in his own personality, confusion or confusion arises, delusional ideas "pop up", the mood is changeable.

With all types of clouding of consciousness, the patient has amnesia, that is, the patient does not remember or does not remember well the period of impairment of consciousness.

Sleep disturbance

Sleep disturbance can be manifested by the inability to fall asleep, short sleep ( man wakes up in the middle of the night) or constant sleepiness. Sleep is disturbed in many mental disorders. Sleep disturbance is rarely seen as a pathology without a cause, that is, a primary illness. Depending on the underlying disease, both psychiatrists and psychotherapists and neurologists can deal with sleep disorders.

A special type of sleep disturbance is sleepwalking ( somnambulism) or sleepwalking. Sleep itself with this disease is not disturbed, a person is fast asleep during night walks, however, the reasons why the brain is "asleep" and the body is awake are also considered by specialists who study the activity of the brain.

Mental retardation

Mental retardation or mental retardation is a mental underdevelopment congenital or acquired up to 3 years of age. At the same time, the function of intelligence suffers ( IQ).

Mental underdevelopment is manifested:

• impaired speech;
• intellectual disability ( thinking);
• ability to self-service;
• the ability to learn new things.

Dementia

Dementia is acquired dementia that occurs in adulthood in severe brain diseases that disrupt its structure ( such diseases are called organic).

The symptoms of dementia are:

• memory impairment, especially remembering new things;
• weak criticism of one's own behavior;
• violation of the thinking process, including a violation of the ability to process the information received;
• lack of signs of impaired consciousness;
• hallucinations, delusions are possible.

Dementia is treated by both psychiatrists and neurologists. Psychiatrists deal with dementia patients, if not the first plan are the symptoms of mental disorders ( hallucinations, delusional thoughts). A neurologist treats cases when the disease is associated with cerebrovascular accident, infection and other structural changes in the brain.

Alzheimer's disease

Alzheimer's disease is a variant of dementia that has a more specific cause. Psychiatric disorders in Alzheimer's are due to amyloidosis. Amyloidosis is a disease that affects many organs, while a special type of protein, amyloid, is formed and accumulates in them, which gradually destroys cells.

Alzheimer's disease is characterized by intermittent short-term episodes of memory loss. The patient can “forget”, leave the house, go in an incomprehensible direction, not remembering his name, address, year of birth. After such episodes, the memory returns again, but the disease progresses.

Parkinson's disease

Parkinson's disease is a neurological disease that is treated by a neurologist, however, due to the fact that dementia and some other mental disorders often develop in this pathology ( psychosis), psychiatrists are actively involved in its treatment. In addition, some drugs ( antipsychotics) prescribed by a psychiatrist have side effects that mimic Parkinson's. The main symptom of Parkinson's disease is tremors or tremors in different parts of the body and freezing in one position.

How is a psychiatrist appointment going?

Reception with a psychiatrist is not much different from that of doctors of other specialties, but it has its own characteristics. The psychiatrist conducts a comprehensive examination of the patient. This allows you to establish not only the presence of behavioral or emotional disorders, but also the connection of symptoms with some other disease.

Reception of a psychiatrist takes place in several stages. To establish a diagnosis, clinical and paraclinical diagnostic methods are used. Clinical methods include patient interviewing and examination ( that is, those methods that are carried out by the doctor himself), and paraclinical - pathopsychological, instrumental and laboratory studies. Clinical methods are basic, and paraclinical methods are auxiliary.

Examination by a psychiatrist includes the following steps:

• Conversation with the patient. A psychiatric examination is, first of all, a conversation with a patient. The psychiatrist asks a person questions about himself, about the world around him, while simultaneously observing his reaction and behavior. The conversation between the psychiatrist and the patient must necessarily take place separately from his relatives. The purpose of the interview is to find out the presence or absence of symptoms of mental disorders and to assess their severity.
• Taking anamnesis Is the collection of data on human life and health. Psychiatric history is subjective ( described from the words of the patient) and objective ( the version of relatives and friends about the patient's condition). The purpose of collecting data is to determine the time of the onset of the disease, to find out the change in the behavior and character of the patient, to establish the presumptive cause of the disorders ( stress, hereditary diseases, acquired diseases and more).
• Physical examination- This is a general examination that includes an assessment of the physique, skin and mucous membranes, listening to the lungs and heart, palpation of the abdomen and other examinations carried out by a general practitioner. The purpose of such an examination is to identify the characteristic external signs of somatic diseases, that is, diseases of internal organs ( somatic diseases include all diseases except mental disorders and diseases of the genital organs). It would seem that diseases of the internal organs should not be of interest to a psychiatrist, but this is not so. The expression "all diseases from the nerves" known today reflects only one side of the coin. The fact is that the interconnection of internal organs and psyche is a two-way street. Dysfunction of any organ affects the work of the brain, especially if the "failure" leads to the accumulation of toxic substances in the body. Therefore, it is important to find out which disorder occurred earlier.
• Neurological examination- includes the study of reflexes, the reaction of the pupil to light, the identification of violations of balance, sensitivity and motor function of muscles. Also, the psychiatrist assesses the patient's speech and hearing. The purpose of a neurological examination is to identify or exclude a structural change in the brain as a cause of mental disorders ( swelling, stroke, hemorrhage), as well as diseases that cause polyneuropathies, that is, damage to many or all of the nerve fibers in the body ( alcoholism, diabetes mellitus).
• Pathopsychological methods diagnostics are psychological tests ( pictures, tasks) or questionnaires ( collection of questions), which allow you to identify the pathology of the psyche.

During the examination, the psychiatrist pays attention to the following behavioral features:

• facial expressions;
• pose;
• gestures;
• arm and leg movements;
• hair pulling;
• nervous tics;
• shiver;
• twitching;
• speech;
• neatness;
• mood;
• a tendency to talk about suicide.

With the help of a psychiatric examination and pathopsychological tests, the psychiatrist determines the following:

• personality type- acquired properties of the psyche or character of a person;
• constitutional predisposition- temperament ( innate character trait), which determines a person's tendency to certain mental disorders;
• mental condition- a description of each function of the psyche ( perception, emotions, memory and others);
• danger behavior- the risk of harming yourself or others.

When describing a mental state, a psychiatrist uses the term “level of mental disorder”. This means that the same disorder can occur with mild or pronounced manifestations.

Level of mental disorders

Index	Neurotic level ( non-psychotic)	Psychotic level
Assessment of events and situations (understanding reality)	Saved, a person can assess his condition, understands that he has a disorder, and is also able to help himself.	Violated, the person does not understand that he is sick and is not able to help himself.
Behavior	Adequate, not dangerous to others.	Inadequate, antisocial.
Criticism	Saved, but can be changed ( increased self-criticism).	Absent ( uncriticality).
Control over emotions and behavior	Saved but limited ( depends on the situation).	Violated ( absent).
The emergence of "new" phenomena (hallucinations, delusions)	Usually absent.	There are.

It is important to know that neurosis and neurotic level of disorder ( like psychosis and psychotic level of disorder) are not synonymous. The neurosis can be difficult, that is, with a psychotic level, and psychosis can have mild symptoms of a neurotic level. Simply put, the level of mental disorder reflects the severity of the symptoms. If the symptoms are mild, this is a neurotic level, and if it is strong, it is a psychotic level.

Healthy people can also be referred to a psychiatrist in order to exclude mental disorders from them. This examination is called a psychiatric evaluation.

The psychiatrist must be "passed" in the following cases:

• obtaining a driver's license;
• permission to carry weapons;
• employment;
• preventive examination in children of the first year of life;
• when a child is admitted to a kindergarten, school;
• upon admission to a higher educational institution;
• to assess the suitability of those called up to do military service.

What problems are they going to a psychiatrist?

Symptoms of mental disorders can be found in a practically healthy person. The concept of "health" includes not only the absence of diseases, but also the mentally comfortable state of a person, that is, the absence of severe emotional experiences that make him suffer. Since mental health can be disturbed superficially and deeply, psychiatry was conditionally divided into large and small. Minor psychiatry includes mental disorders in which a person is able to control himself and help himself. It is customary to treat these disorders by a psychotherapist or a psychiatrist who uses psychotherapy methods in his practice. "Big" psychiatry deals with the treatment of deeper mental disorders.

"Big" psychiatry includes pathologies in which there is at least one of the following symptoms:

• breaking the connection with reality- the person does not understand where he is, what year it is ( can present his version of reality);
• violation of self-awareness- a person ceases to be aware of his "I" and can declare that he is, for example, a cat;
• "Plus-symptomatology"- these are "new" phenomena that are products of a diseased psyche, for example, hallucinations, delusions, or movement disorder ( the psychiatrist calls these symptoms positive or productive);
• "Minus symptoms"- loss of mental functions, for example, memory impairment or dementia ( psychiatrists refer to such symptoms as negative or deficient).

Pathologies with which you should consult a psychiatrist

Pathology	Main reasons	Pathology treatment method
Neurotic disorders (hysteria, fears, obsessive thoughts)	psycho-emotional overload; mental trauma; unexpressed emotions; constitutional predisposition.	psychotropic ( affecting the psyche) drugs; psychotherapy.
Psychoses (hallucinations, delusions)	alcohol intoxication; intoxication with narcotic or toxic drugs; mental trauma; traumatic brain injury; infection; brain tumors; diseases of the internal organs.	psychotropic drugs; electroconvulsive therapy; psychotherapy.
Personality disorders	the impact of adverse factors on the fetal brain; mistakes in education; genetic predisposition; alcoholism; drug addiction and substance abuse; infections; birth trauma; wrong upbringing.	psychotherapy; psychotropic drugs.
Schizophrenia	"Slow" brain infections caused by prions ( proteinaceous infectious particles); drug addiction ( smoking marijuana).	psychotropic drugs; electroconvulsive therapy; insulin therapy; psychotherapy.
Affective disorders (depression, manic state)	genetic reasons; excess or deficiency of hormones due to a violation of the nervous regulation of their formation ( neuroendocrine disorders); depletion of mechanisms for overcoming stress with frequent psycho-emotional experiences; alcoholism; drug addiction and substance abuse; severe debilitating diseases of the internal organs.	psychotropic drugs; electroconvulsive therapy; insulin therapy; vagus nerve stimulation psychotherapy; psychosurgery.
Psychomotor disorders (motor-emotional disorders)	stress; infections; intoxication; traumatic brain injury; alcoholism; drug use and substance abuse.	psychotropic drugs; psychotherapy.
Clouding of consciousness	drug addiction; alcoholism; traumatic brain injury; infections; intoxication.	detoxification; psychotropic drugs.
Memory impairment	drug intoxication; alcoholic intoxication; traumatic brain injury; severe stress; brain damage.	nootropics.
Epilepsy	hereditary predisposition; canalopathy - instability of the ion channels of nerve cells, which ensure the transmission of nerve impulses; brain tumors; brain injury; neuroinfection.	anticonvulsants; stimulation of the vagus nerve.
Oligophrenia	hereditary diseases; fetal brain damage during pregnancy; infections and traumatic brain injury in children under 3 years of age.	psychotherapy; nootropics.
Dementia	brain injury; vascular diseases of the brain; brain tumors; infections; hereditary disease; amyloidosis ( deposition of a special protein, amyloid, in the brain, which causes the destruction of neurons).	psychotropic drugs; surgery ( performed by neurosurgeons).
Autism	hereditary diseases; some external factors ( infections, intoxication).	psychotherapy; psychotropic drugs.
Sleep disturbance	physical and emotional stress; alcoholism; drug addiction; infectious diseases; diseases of the internal organs; damage to the vessels of the brain; brain damage.	psychotropic drugs; psychotherapy.

The diagnosis made by a psychiatrist consists of the main syndromes. For example, in the presence of hallucinations and depression, the diagnosis "depressive-hallucinatory syndrome" is made. And there are many such options.

What kind of research does a psychiatrist do?

A psychiatrist prescribes instrumental and laboratory research methods not so much with the aim of making a diagnosis, but in order to find out the cause of mental disorders. A mental disorder can have functional causes, when the function of an organ is impaired, but its structure remains unchanged, and organic causes, in which brain tissue is damaged.

If organic changes in the brain are found, then the treatment of mental disorders is carried out in parallel with an attempt to eliminate their cause. In addition, it is important to remember that a mental disorder can be a manifestation of another disease, for example, diseases of the internal organs, infectious diseases. In most cases, however, no serious changes in the brain or other "objective" cause can be detected, and then the psychiatrist begins to treat the manifestation of the disease, that is, its symptoms.

Research ordered by a psychiatrist

Study	What pathologies does it reveal?	How is it done?
Instrumental research methods
Electroencephalography (EEG)	epilepsy; autism; substance abuse ( taking tranquilizers); vascular diseases of the brain ( stroke); metabolic disorder of the brain ( metabolic encephalopathy); dementia; Alzheimer's disease; brain tumors; traumatic brain injury; increase.	Active electrodes attached to the cap are applied to the scalp, which record the bioelectric activity of the brain in the form of waves of different amplitudes. Inactive electrodes ( to compare data) are placed on the earlobes. The electrode can be inserted through the nose to detect epilepsy. To reveal hidden violations, stress tests are carried out - the patient is given a medicine to drink, flashes of light, sounds are turned on, they are offered to complete tasks. Sometimes the study is carried out during sleep or during the day ( EEG monitoring). The procedure does not require special preparation. Hair should be clean and free of hair sprays or gels. Before the procedure, medications that may interfere with the test results are usually discontinued.
Rheoencephalography	cerebrovascular disease).	The principle of operation of the method differs from EEG in that during rheoencephalography, an electric current is recorded, which appears when the vessels of the brain are filled with blood during each pulse wave. Thus, you can get an idea of ​​the tone of the vessels of the brain, their elasticity and filling with blood. The electrodes are attached to a rubber band that is worn as a rim. The headband should go over the eyebrows and ears. Two electrodes on each side are placed above the eyebrows, behind the ears and in the occipital region. Hair is collected with hairpins on the head so that it does not fall on the electrodes.
Echoencephalography	stroke; violation of cerebral circulation; Parkinson's disease; brain tumors; encephalopathy ( non-inflammatory brain damage).	The study is carried out with the patient lying or sitting. The ultrasound transducer is placed on the right and left sides in the temporal region, after applying a gel to the area for better gliding of the transducer. Ultrasound tends to be reflected from tissues with different densities. The reflected signal is picked up by the same sensor that sends it, after which the signal is transmitted to the monitor in the form of a curve. The curve has peaks that correspond to the density of the area in the brain that reflects the ultrasound signal.
Doppler ultrasonography		Doppler ultrasound is an ultrasound diagnostic method that allows you to examine the blood flow in the vessels. To examine the vessels of the brain, an ultrasound sensor is installed over the area of ​​specific cerebral vessels, namely in the region of the temple, occiput, and eye. In addition, in order to identify a violation of blood circulation in the brain, it is necessary to examine the vessels of the neck, which carry blood to the intracranial vessels.
Craniography	traumatic brain injury; brain tumors.	Craniography is an X-ray examination of the bones of the skull without the use of contrast agents. The study is carried out in a sitting or lying position.
Angiography	cerebrovascular disease; brain tumors.	Angiography of the cerebral vessels is a procedure for "staining" the arteries that enter the brain. This is achieved by injecting a contrast agent into the vessels. After contrasting the arteries, they become visible on x-rays.
CT scan (CT scan)	schizophrenia; epilepsy; a brain tumor; stroke; dementia; Alzheimer's disease; mental retardation.	During computed tomography ( CT scan) the patient lies down on the diagnostic table, the movement of which inside the tomograph is regulated by the radiologist performing the diagnostic study. In addition, the tomograph itself moves, which makes it possible to obtain sections of the examined part, which, after computer processing, allow the doctor to obtain a picture of the brain. To "paint" the vessels of the brain, a contrast agent is injected intravenously.
Magnetic resonance imaging (MRI)	epilepsy; atrophic, degenerative brain disease; Alzheimer's disease; stroke; a brain tumor.	During an MRI, the patient lies on the diagnostic table, which, like during CT, is moved into the tunnel of a round tomograph. Pre-remove all metal objects, the patient puts on headphones or earplugs ( there is a lot of noise during the MRI), and a so-called coil is installed over the area under study.
Positron emission tomography (PAT)	schizophrenia; cerebrovascular accident ( stroke); epilepsy; Alzheimer's disease; brain tumors.	The method allows you to study the metabolism in the brain. The patient is injected intravenously with radioactive isotopes that are associated with the main substances involved in cell metabolism ( water, carbon dioxide, deoxyglucose and others). The examinee is placed on the diagnostic table and the gamma camera is brought closer, which perceives the radiation emanating from the radio preparations. As a result, a schematic image of the brain is obtained, on which the places of accumulation of isotopes are indicated in a certain color.
Spinal cord puncture	neuroinfection ( inflammation of the brain); cerebral hemorrhage ( hemorrhagic stroke); brain tumors.	Puncture ( puncture) of the spinal cord is held in the lumbar spine to obtain cerebrospinal fluid. This liquid is sent to a laboratory to study its composition, if there is a suspicion of damage to the central nervous system ( brain and spinal cord).
Laboratory research methods
Analysis of blood, urine and feces	somatic diseases ( diseases of internal organs); endocrine disorders.	All tests are taken in the morning. A blood test is taken on an empty stomach. Before collecting urine, a toilet of the external genital organs is performed. Blood is taken from a vein so that it is sufficient for a general blood test and a biochemical blood test, including an analysis for hormones.
Blood test for infections	acquired immunodeficiency syndrome ( AIDS);	A blood test can detect antibodies to the causative agents of certain infections that can cause mental disorders.
Genetic analyzes	hereditary causes of oligophrenia; epilepsy; schizophrenia; Alzheimer's disease; oligophrenia ( for example, Down syndrome and other chromosomal diseases).	For genetic analysis, blood is taken from a vein or a smear from the oral mucosa ( cheeks).
Skin allergy tests	infectious diseases causing mental disorders ( brucellosis, tuberculosis); neuroses ( itchy skin).	With the help of skin tests, the body is allergic to the causative agents of some infections. To identify allergies with a syringe or scarifier ( skin lancing device) into the skin of the forearm ( from the inside) introduce known allergens ( proteins causing allergies). After 2 days, the result is assessed by the size of the seal that appears at the injection site. In addition, these tests make it possible to distinguish between nervous and allergic itching.
Tests for the presence of drugs in blood, urine and saliva	drug addiction.	Blood, urine, or saliva is applied to the test strip. By the type of color change or when stripes appear, it is determined whether there is a narcotic substance in the body.
Breath Alcohol Test	alcoholic intoxication.	A person is offered to exhale into the tube of a special apparatus that calculates the amount of alcohol in the body.

Many studies are difficult to conduct if a person has a severe mental disorder, as they cannot control their behavior and follow the doctor's recommendations during the diagnostic procedure. Sometimes the study is carried out after the administration of drugs that calm the psyche and relax the patient's muscles.

The psychiatrist prescribes laboratory tests for the following purposes:

• exclusion or confirmation of diseases of internal organs, especially liver and kidneys, as a cause of mental disorders;
• choice of treatment options;
• evaluation of the effectiveness of the treatment;
• monitoring the patient's condition against the background of treatment.

Before starting treatment, women must be prescribed a pregnancy test, since many drugs have an adverse effect on the fetus. Elderly patients are given an electrocardiogram ( ECG) .

What methods does a psychiatrist treat?

Despite the widespread perception of mental disorders as incurable pathologies, most mental disorders are easily treatable. The treatment prescribed by the psychiatrist is always individual. That is, unlike other diseases for which treatment templates have been developed, mental disorders turned out to be so different for each person that it was not possible to fit them to the overall size ( despite the fact that Western experts are trying to do it). In general, due to the difficulties in studying the causes of mental disorders, it is customary in psychiatry to treat syndromes, that is, in addition to the main complaint ( for example depression), the psychiatrist can identify other disorders, after which it will be clear what kind of syndrome it is ( e.g. manic-depressive) and how to treat it.

We can say that psychiatry is the branch of medicine where a doctor can carry out symptomatic treatment ( unlike other medical disciplines). The choice of the drug and its dose is always individual, and the psychiatrist seeks to prescribe one drug in the minimum effective dose.

If the mental disorder is a symptom of another medical condition ( pathology of the brain, internal organs), then the treatment is carried out in conjunction with other specialists ( neurosurgeon, therapist, neurologist).

Major disorders and treatments in psychiatry

Pathology	Treatment method	The mechanism of therapeutic action	Approximate duration of treatment
Neurotic disorders (neurosis)	Tranquilizers	Tranquilizers inhibit the structures of the brain that regulate a person's emotional responses without affecting other parts of the brain.	Usually, drug treatment is prescribed during an exacerbation, and in the psyche ( drugs must be taken for at least 2 weeks).
	Nootropics	Nootropic drugs improve metabolism and bioenergetic processes in nerve cells.
	Antidepressants	Antidepressants prevent the destruction of monoamines ( dopamine, norepinephrine, serotonin), which are responsible for a good mood.
	Psychotherapy	Psychotherapy for neuroses is aimed at a conscious change in attitude, that is, a person's reaction to a traumatic situation, since in the absence of a stressful cause, symptoms do not arise.	The therapy continues until the effect is obtained.
Psychoses	Antipsychotics (antipsychotic drugs)	Antipsychotics relieve psychomotor agitation ( hallucinations, delusions, movement disorders), blocking receptors ( nerve endings) sensitive to the neurotransmitter dopamine ( substance-transmitter of nerve impulses).	The duration of drugs and psychotherapy courses is determined by the cause. If it is caused by intoxication, then the drugs are canceled after the condition has stabilized. With psychoses, which are an independent disease ( e.g. schizophrenia), drugs are taken constantly.
	Psychotherapy	In psychoses caused by alcoholism or drug addiction, psychotherapy is aimed at eliminating those psychological problems that made a person look for positive emotions in alcohol and drugs, and also teach them to "switch" to other joys of life.
Depression	Antidepressants	Antidepressants promote the accumulation of neurotransmitters ( dopamine, serotonin, norepinephrine), which normalizes the depressed activity of the mood center.	For severe depression, drugs can be prescribed for a long time ( 2 - 3 years).
	Tranquilizers	Tranquilizers have a calming effect, relieve anxiety and seizures, due to an increase in inhibitory reactions in the brain.
	Electroconvulsive therapy	The principle of therapeutic action is the effect of an electric current on the brain with the aim of causing convulsions throughout the body. This exposure is believed to trigger the release of serotonin, dopamine, and norepinephrine, all of which support a good mood.	2 sessions are carried out every week, the total number of sessions is no more than 12.
	Vagus nerve stimulation	When the vagus nerve is stimulated, it sends impulses to the center of the brain that controls mood.	After implantation of the device under the skin, it works from the built-in battery for up to 3 - 5 years.
	Psychosurgery	With the help of high temperatures or gamma radiation, they destroy the connections of the frontal lobes of the cerebral cortex with the subcortical structures. It is in the frontal lobe that the mood-forming centers are located.	–
	Psychotherapy	Psychotherapy is carried out in conjunction with treatment. The therapeutic effect of psychotherapy appears after a person realizes the reasons that led him to depression.	In case of depression, it is carried out while taking medications. The duration and type of psychotherapy are set individually ( if there is an effect, therapy is continued).
Manic syndrome	Tranquilizers	Tranquilizers have a calming effect, relieve anxiety and seizures.	The drugs are used on an ongoing basis under the supervision of a physician ( at least 3 - 5 years).
	Normotimics	Normalizers are mood stabilizers. On the one hand, normotimics increase the amount of the inhibitory substance GABA ( gamma-aminobutyric acid), reducing the excitability of the brain, and on the other hand, contribute to the normalization of the level of dopamine, which is responsible for maintaining mood.
	Antipsychotics	Antipsychotics block dopamine receptors, regulating mood. The therapeutic effect is manifested in the normalization of mental activity and the removal of an overexcited state.
	Electroconvulsive therapy	It is believed that the effect of an electric current on the brain causes it to "shake" and restore the sensitivity of the brain receptors to neurotransmitters.	There are 2 sessions per week, the total number of sessions is no more than 12.
Psychopathies (personality disorder)	Psychotherapy	It is the main method of treating psychopathies, but only in those cases when the patient is aware of his disharmonious nature and wants to change. In this case, the main effect ( self-acceptance and behavior change) are obtained through self-hypnosis and talking with a doctor. In severe cases, hypnosis is used.	It is carried out for a long time.
	Drug treatment	Drug treatment is carried out with psychotropic drugs ( tranquilizers, antidepressants, antipsychotics, normotimics) in order to smooth out the most striking manifestations ( neurosis, depression, mania and others).	Usually conducted by courses ( several months) with an exacerbation of the disease, less often it is prescribed for a long time ( up to 1 year).
Clouding of consciousness	Detoxification	Allows you to neutralize and remove toxic products from the body, especially with alcohol or drug intoxication.	Clouding is treated in a hospital setting, usually for 10 to 14 days ( simultaneously treat the underlying cause).
	Antipsychotics	Antipsychotics normalize psychomotor ( emotional and motor) disorder with overexcitation, "return" a person to reality.
Schizophrenia	Antipsychotics (antipsychotic drugs)	Antipsychotics "cut off" the nerve impulses that cause the appearance of psychotic disorders, while the psyche ceases to create hallucinations, motor excitement is eliminated.	The drug is taken for at least 4 to 6 weeks to determine its effectiveness, after which the drug is prescribed in the optimal dose on an ongoing basis ( supportive therapy).
	Electroconvulsive therapy	The impact of an electric current on the brain causes it to "reboot", after which the patient's psyche begins to work "from scratch."	The therapy is carried out in short courses.
	Insulin therapy	The principle of therapy is based on the introduction of a sufficient amount of insulin to induce coma, however, the mechanism of action of this method is still unknown. Insulin therapy is used if there is no effect from medications and with recent schizophrenia.	The therapy is carried out in courses.
	Psychotherapy	The mechanism of action of psychotherapy in schizophrenia is based on a change in the patient's attitude to his hallucinations, that is, it helps to abstract at the moment of their appearance, make them disappear, or simply stop being afraid.	This method is carried out after stabilization of the patient's condition, for a long time.
Epilepsy	Anticonvulsants (anticonvulsants, antiepileptic drugs)	The anticonvulsant effect is achieved by a decrease in seizure activity ( an increase in the threshold of excitability) of the brain, thus the brain cells become less sensitive to spontaneous nerve discharges.	The duration of treatment with antiepileptic drugs depends on the risk of recurrence of seizures. At a low risk level, treatment can be canceled if there have been no attacks within 2 years, at a high risk - after 5 years.
	Vagus nerve stimulation	The impulses that the vagus nerve sends to the brain can stop an epileptic seizure.	After implantation of the device under the skin, it works from the built-in battery for 3 - 5 years.
Dementia, Alzheimer's disease	Cholinergic replacement therapy	The mechanism of action is based on the restoration of the deficiency of acetylcholine in the brain, which is responsible for such functions as intelligence, memory, speech.	Treatment is carried out for a long time ( efficacy is assessed after 6 months while taking medication).
	Glutamate receptor blockers	The blockade of glutamate receptors prevents further damage to nerve cells that occurs under the influence of glutamate, a substance that excites the brain.
Oligophrenia (mental underdevelopment)	Nootropics	The drugs improve the metabolism in nerve cells, as a result, the brain perceives new information better, that is, the ability to learn increases.	Apply for a long time.
	Psychotherapy	The mechanism of action is that during the training of a child with oligophrenia ( in a playful way) create a comfortable state in him, which is achieved by constant encouragement of what he does, regardless of the results. Thus, the child learns to experience the world without discomfort.	For children with mental retardation, an individual schedule of activities is formed, which must be carried out for a long time and regularly.
Autism	Psychotherapy	It is the main treatment for autism. The mechanism of action consists in influencing the psyche with words, activities, support, which gradually helps him to eliminate personality defects and adapt.	Most effective in childhood autism. For children, various development and training programs have been created, which are carried out at different stages of the development of the psyche.
	Nootropics	Nootropics allow the brain to function "at full power", due to the beneficial effect on metabolic processes in it.	The need for behavior correction with drugs is determined depending on the age and severity of autism.
	Antipsychotics	Eliminate an aggressive agitated state.
Sleep disturbance	Tranquilizers	Tranquilizers help calm the “restless mind,” and at higher doses, have a hypnotic effect.	Apply in short-term courses during exacerbation of neurotic and mental disorders.
	Antidepressants	Antidepressants are effective if the cause of sleep disturbance is a depressive, depressed state of the psyche.	They can be prescribed by a doctor for short or long courses, depending on the severity of the condition and the cause.
	Psychotherapy	With the help of psychotherapy, it is possible to relax, solve problems that prevent sleep, or, conversely, activate consciousness in case of pathological drowsiness ( occupational therapy).	With neurotic disorders, it effectively helps to cope with sleep disorders. The number of sessions is set individually.
Memory impairment	Nootropics	Nootropics improve the ability to remember new incoming information.	Apply for a long time ( several months).

Psychiatry(ancient Greek ψυχή (psychḗ), soul + ἰατρεία (iatreía), treatment) is a branch of clinical medicine that studies mental disorders through the prism of medicine methodology, methods of their diagnosis, prevention and treatment. This term also means a set of state and accredited non-state institutions, in some countries having the right to involuntary isolation of persons who pose a potential danger to themselves or others.

The definition of psychiatry as the doctrine of the recognition and treatment of mental illnesses, proposed by the German psychiatrist Wilhelm Griesinger (1845), has gained wide recognition. According to a number of modern authors, this definition “contains the most essential features of this medical discipline”, “accurately formulates the tasks facing psychiatry”, given that:

Recognition means not only diagnosis, but also the study of the etiology, pathogenesis, course and outcome of mental disorders. Treatment, in addition to the actual therapy, includes the organization of psychiatric care, prevention, rehabilitation and social aspects of psychiatry.

Obukhov S.G. Psychiatry / Ed. A. Aleksandrovsky - M .: GEOTAR-Media, 2007 .-- P. 8.

The term "psychiatry" was proposed in 1803 by the German physician Johann Christian Reil (German. Johann reil; 1759-1813) in his famous book "Rhapsodies" (Rhapsodien. 1803, 2nd ed. 1818), where, according to the characteristics of Yu. V. Kannabikh, "the foundations of" real psychiatry "are laid out, that is (taking this word literally) - treatment mental illness ". V.A.Gilyarovsky called this term an anachronism, since he

suggests the existence of the soul or psyche as something independent of the body, something that can get sick and that can be healed by itself.

- Gilyarovsky V.A. Psychiatry. A guide for doctors and students. - M .: MEDGIZ, 1954.S. 9.

“This,” continues A. Ye. Lichko, “does not correspond to our modern concepts of mental illness,” and there were attempts to replace the term “psychiatry” with another.

For example, V. M. Bekhterev suggested the name "pathological reflexology", V. P. Osipov - "tropopathology" (from the Greek tropos - mode of action, direction), A. I. Yushchenko - "personopathology". These names did not find followers, and the term "psychiatry" remained, which has lost its original meaning.

Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry: Textbook. - M .: Medicine, 1995. S. 5-6.

N.N. Pukhovsky, arguing that the use of "psychiatry", "psychiatric disorders" neuroticizes the doctor and disorients the patient, and noting the duality of ideas about the nature and essence of the subject of psychiatry (which usually means, on the one hand, the metaphysical "mental disorder as a symbolic organ of a person ", on the other -" pathology of the human brain as an organ of the mind "), suggests returning to practice the previously used terms" phreniatrics "and" alienistics "and highlighting two independent areas of therapy for mental disorders: phreniatrics (treatment of pathology of the brain as an organ of the mind) and psychotherapy (correction of disorders of self-determination of a person by psychological methods).

General information

There is no single agreed definition of the concepts of "disease-health" and "norm-pathology" in psychiatry. According to one of the common definitions, a mental illness is a change in consciousness that goes beyond the "reaction norm". Many researchers talk about the fundamental impossibility of giving a definition of "normal behavior", since in different cultures and in different historical situations, the criteria for mental norms differ.

Psychiatry is divided into general and specific:

If private psychiatry studies individual diseases, then general psychopathology, or rather, general psychiatry, studies the general patterns of mental disorder ... Typical psychopathological states can occur in various diseases, therefore, they have a general meaning ... General psychiatry is based on the generalization of all those changes that occur in the course of certain mental illnesses.

Snezhnevsky A.V. General psychopathology: A course of lectures. - M .: MEDpress-inform, 2001.S. 7-8.

This understanding by A.V. Snezhnevsky of general psychiatry as a general psychopathology is recognized by many Russian psychiatrists, but is not generally accepted. In particular, in addition to general psychopathology, pathopsychology is sometimes included in general psychiatry. Private psychiatry is sometimes called private psychopathology.

Signs (symptoms) of mental disorders are the subject of psychiatric semiotics.

The manifestations, symptoms of mental illness, the biological essence of those pathological changes in the body that lead to mental disorders are studied by clinical psychiatry.

Thus, modern psychiatry studies the etiology, pathogenesis, clinic, diagnosis, treatment, prevention, rehabilitation and examination of mental disorders. In turn, examination in psychiatry is divided into: forensic psychiatric examination, military psychiatric examination and medical and social examination (labor).

Examination Methods in Psychiatry

Psychiatric diagnosis is established on the basis of facts obtained by different methods - clinical and laboratory. The main method of psychiatry is clinical research.

Diagnostics in psychiatry is largely subjective and probabilistic in nature, which leads to frequent cases of overdiagnosis. Unlike diagnoses made by doctors of other directions, who reveal the pathology of specific organs and systems, psychiatric diagnostics includes, among other things, an assessment of the reflection of the external world and the events occurring in it: in other words, a psychiatric diagnosis is an assessment of the picture of the world of a patient and a doctor with positions of concepts and diagnostic criteria used in a specific historical period in the development of society and science.

The priority of the clinical method, the subordinate position of instrumental techniques give rise to accusations of the subjectivity of diagnostics in psychiatry. Denial of the possibility of an objective diagnosis in psychiatry leads to denial of the existence of mental illness in general and of psychiatry itself as a science.

Zharikov N.M., Ursova L.G., Khritinin D.F. Psychiatry: Textbook - M .: Medicine, 1989. P. 251

"Until now, for several centuries, there has been a debate about whether psychiatry is a science or an art." According to critics, there is no real evidence of the scientific nature of psychiatry, as well as the effectiveness of its methods.

Kittrey investigated a range of deviant manifestations, such as drug addiction, alcoholism and mental illness, and demonstrated that such manifestations were considered first moral problems, then legal problems, and are now considered medical problems. As a result of this perception, extraordinary people with deviations from the norm were subjected to social control of a moral, legal and then medical nature. Likewise, Konrad and Schneider conclude their review of the medicalization of deviance with the view that one can find three main paradigms on which the meanings of the concept of deviance in different historical periods depended: deviance as a sin, deviance as an offense, and deviance as a disease.

History of psychiatry

The history of psychiatry dates back to ancient times. As with any other science, the starting point for the beginning of the existence of psychiatry can be considered either the moment of registration in the public consciousness of the concept of the object of what later became a science (in this case, mental disorders), or the moment of appearance of the first scientific knowledge (at least, extant).

Psychiatry in a primitive society

In ancient times, what is understood today as mental illness was explained on the basis of religious and mystical ideas. As a rule, insanity was associated with curses, the intervention of dark forces, and possession by evil spirits. Since mental activity was already associated with the head at that time, the usual practice, apparently, was trepanning of the skull in order to "release" the spirits outside. Another part of mental disorders was associated with "divine disposition", "the sign of being chosen." For example, epilepsy was considered such long before Hippocrates. The issue of mental disorders associated with the use of psychoactive substances stands somewhat apart (according to modern concepts). Currently, this issue is dealt with by a science called narcology.

Psychiatry in the late XIX - early XX century

In the science of mental disorders in the late 19th and early 20th centuries, two schools stood out, among others. The first is psychoanalysis, which began with the work of Sigmund Freud (1856-1939), who laid the foundation for the theory of the unconscious. According to this doctrine, in the human brain, a region of animal instincts was distinguished (the so-called "It", opposed to the personal "I" and "Super-I" - the dictate of society, which commands the personality and imposes certain norms of behavior). The unconscious, from the point of view of Freud and his followers, became a prison for forbidden desires, in particular - erotic ones, displaced into it by consciousness. In view of the fact that it is impossible to completely destroy desire, for its safe implementation, consciousness proposed a mechanism of "sublimation" - implementation through religion or creativity. A nervous breakdown in this case was presented as a failure in the mechanism of sublimation and the splashing out of the forbidden through a painful reaction. To restore the normal functioning of the personality, a special technique was proposed, called psychoanalysis, which involved returning the patient to childhood memories and resolving the problem that had arisen.

Freudianism was opposed by the school of positivist medicine, one of the outstanding figures of which was Emil Kraepelin. Kraepelin based his understanding of mental disorder on progressive paralysis and proposed a new form for the time of studying the disease as a process that develops in time and breaks down into certain stages, described by a certain set of symptoms. Based on the philosophy of positivism, in particular, on the principle "science is philosophy", in other words - the proclamation of only the results of experience or scientific experiment as real as opposed to the scholastic thinking of earlier times, positivist medicine offered an explanation of mental disorder as a biological disorder, destruction of brain tissue caused by causes of multiple nature.

However, neither the one nor the other theories could claim an unambiguous and evidentiary substantiation of the cases already described in the literature or known from clinical practice - for example, Freud and his followers were reproached for the speculative and unsystematic nature of their constructions, for the arbitrary interpretation of the examples given. In particular, Freud built his theory of child sexuality on the psychoanalysis of adults, explaining the impossibility of confirming it in children by the fear of a forbidden topic.

In turn, opponents reproached Kraepelin for the fact that the theory of organic defeat de facto reduced madness to emotional and mental degradation. The cure of a mental patient was a priori declared at that time impossible, and the doctor's work was reduced exclusively to supervision, care and relief of possible aggression. In addition, it was pointed out that the positivist theory was unable to explain the numerous cases of mental disorders, while no biological damage could be found.

Phenomenological Psychiatry

As one of the ways out of the outlined impasse, Edmund Husserl and his followers proposed a method called phenomenological.

Its essence was reduced to the allocation of certain "phenomena" - ideal entities that are a reflection of objects of the real world, as well as one's own "I" in the consciousness of the individual. These phenomena, idealized facts, cleansed of the emotional and social component, represented, according to Husserl, the basis of all knowledge - despite the fact that they did not exist in reality, but were inextricably linked with the cognizing subject. Philosophy, therefore, was supposed to serve as the completion of any research, representing its quintessence and rigorous system at the level of scientific understanding, and phenomenology - as an instrument of this knowledge.

The application of the phenomenological method in psychology and psychiatry was based on the postulate of the "corporeality of the mind" - the inextricable connection of a person with the outside world and the ability for consciousness to function normally exclusively in this connection. Violation of such, confusion of perception in the transmission of external impressions to the mind is the essence of mental illness. The restoration of this connection accordingly leads to recovery. The method of achieving phenomenological clarity of reason, however, was to clarify, bracketed the emotional aspect and a clear view of the world that was not clouded by prejudice, which received a special name from phenomenologists "epoch".

K. Jaspers, who began his medical career in 1909 at the Heidelberg Psychiatric Clinic, where the famous Kraepelin had worked not long before, was critical of his legacy and the approach to the treatment and care of patients practiced in the clinic). In contrast, he, relying on Husserl's theory, developed the phenomenological method precisely in the application to psychopathology, proposed a detailed interviewing of the patient to highlight the main phenomena of his consciousness and their further classification in order to make a diagnosis ( descriptive phenomenology). In addition to this, J. Minkowski suggested using the so-called. the method of structural analysis to highlight the main disorder to which the disease owes its occurrence ( structural analysis). G. Ellenberg, in turn, proposed, on the basis of phenomenology, a method for reconstructing the patient's inner world ( categorical analysis). The immediate result of this approach was respect for the patient as a person and the specialist's focus on understanding, but by no means imposing on the patient a view of things that was alien to him.

General psychiatry

All mental disorders are usually divided into two levels: neurotic and psychotic.

The border between these levels is conditional, however, it is assumed that gross, pronounced symptoms are a sign of psychosis ...

Neurotic (and neurosis-like) disorders, on the other hand, are characterized by mild and smooth symptoms.

Mental disorders are called neurosis-like if they are clinically similar to neurotic disorders, but, unlike the latter, are not caused by psychogenic factors and have a different origin. Thus, the concept of the neurotic level of mental disorders is not identical with the concept of neuroses as a group of psychogenic diseases with a non-psychotic clinical picture. In this regard, a number of psychiatrists avoid using the traditional concept of "neurotic level", preferring more precise concepts of "non-psychotic level", "non-psychotic disorders" to it.

Neurotic and psychotic concepts are not associated with any particular disease.

Zharikov N.M., Tyulpin Yu. G. Psychiatry: Textbook. - M .: Medicine, 2002 .-- S. 71.

Disorders of the neurotic level often debut progressive mental illnesses, which subsequently, as the symptoms worsen, give a picture of psychosis. In some mental illnesses, such as neuroses, mental disorders never exceed the neurotic (non-psychotic) level.

PB Gannushkin suggested calling the entire group of non-psychotic mental disorders "small", and VA Gilyarovsky - "borderline" psychiatry. The terms "borderline psychiatry", "borderline mental disorders" are often found on the pages of publications on psychiatry.

Productive symptoms

In the case when the result of the work of the mental function is mental production, which normally should not be, such mental production is called "positive", "productive" symptomatology. Positive symptoms are usually a sign of a medical condition. Diseases, the key symptoms of which are this kind of "positive" symptomatology, are usually called "mental illnesses" or "mental illnesses". Syndromes formed by "positive" symptoms in psychiatry are usually called "psychoses". Since a disease is a dynamic process that can end with either recovery or the formation of a defect (with or without a transition to a chronic form), then this kind of "positive" symptomatology ultimately either goes away or forms a defect, which in the work of mental function in psychiatry it is customary to call it "dementia", or dementia.

Productive symptoms are not specific (associated with any specific disease). For example, delusions, hallucinations, and depression can be present in the picture of various mental disorders (with different frequencies and characteristics of the course). But at the same time, there is an "exogenous" (that is, caused by reasons external to the brain cells) type of reaction of the psyche, for example, exogenous psychoses, and an endogenous type of response (psyche) (that is, caused by internal causes), or "endogenous" disorders, which include primarily schizophrenia, schizophrenic spectrum disorders, and unipolar endogenous depression. Since the 19th century, there has been a concept in psychiatry that is shared only by a fraction of psychiatrists; according to which endogenous psychoses are a single disease (the so-called theory of a single psychosis); however, most psychiatrists are still of the opinion that schizophrenia and endogenous affective psychoses are clearly opposed to each other.

Endogenous is one of the key concepts in psychiatry. Sometimes they indicate the ambiguity of this concept:

The concept of "endogenous" is ambiguous and controversial. It means "not somatically conditioned" and "non-psychogenic." The same thing that should define "endogenous" positively sounds ambiguous. A number of psychiatrists think about nothing else than "idiopathic", that is, about a disease originating from itself; some postulate an organic cause, even if it remains unknown (cryptogenic). Based on the current level of knowledge, we can only say specifically that "endogenous" psychoses are hereditary and have their own course, independent of external influences. Then the concept of "endogenous" becomes unnecessary.

Tölle R. Psychiatry with elements of psychotherapy. / Per. with him. G.A. Obukhova. - Minsk: Vysh. shk., 1999. - S. 42.

Negative symptoms

“Negative symptomatology (deficit, minus-symptomatology) is a sign of persistent loss of mental functions, a consequence of breakage, loss or underdevelopment of some links of mental activity. The manifestations of a mental defect are memory loss, dementia, dementia, a decrease in the level of personality, etc. It is generally accepted that positive symptoms are more dynamic than negative; it is changeable, capable of becoming more complex and, in principle, reversible. Deficient phenomena are stable, they are highly resistant to therapeutic influences "

Zharikov N.M., Ursova L.G., Khritinin D.F. Psychiatry: Textbook. - M .: Medicine, 1989. S. 161-162.

The concepts of both “productive” and “negative” symptomatology are applicable to mental function.

Perceptual disturbances

There can be no defect (negative symptomatology) for perception, by definition, since perception is the primary source of information for mental activity. Positive symptoms for perception include illusion (incorrect assessment of the information received from the sense organ) and hallucination (disturbance of perception in one or more sense organs (analyzers), in which the false (imaginary) perception of non-existent information not received by the sense organs is interpreted as real).

Perceptual disorders are also usually classified according to the sense organs to which the distorted information belongs (for example: "visual hallucinations", "auditory hallucinations", "tactile hallucinations", which are also called senestopathies).

Sometimes, disturbances in thinking are added to disturbances in perception, and in this case, illusions and hallucinations receive a delusional interpretation. Such delirium is called "sensual". This is figurative delirium, with a predominance of illusions and hallucinations. Ideas with him are fragmentary, inconsistent - primarily a violation of sensory cognition (perception).

Memory impairment

The problem of positive symptomatology for the mental function "memory" will be discussed further (in the section "Conclusion").

Dementia, in which a memory disorder is the key disorder, is the so-called "organic brain disease".

Thinking disorders

For thinking, a productive symptom is delirium - an inference that arose not as a result of processing incoming information and is not corrected by incoming information. In ordinary psychiatric practice, the term "thought disorder" is understood as either delirium or various disorders of the thinking process.

Disturbances of affect

Positive affective symptomatology is mania and depression (increased or, accordingly, decreased mood, which is not the result of an assessment of the information received and does not change or slightly changes under the influence of the incoming information).

The flattening of affect (that is, its smoothing), resulting from schizophrenia, is usually not called the term "passion disorder" in psychiatric practice. This term is used precisely to refer to positive symptoms (mania and / or depression).

Conclusion

The following circumstance is key for psychopathology: mental illness, which is characterized by a productive disorder (psychosis) in one of the mental functions, causes negative disorders (defect) in the next mental function... That is, if positive symptoms of perception (hallucinations) were noted as a key symptom, then negative symptoms of memory should be expected. And in the presence of positive symptoms of thinking (delirium), one should expect negative symptoms of affect.

Since affect is the final stage in the processing of information by the brain (that is, the last stage of mental activity), then a defect does not occur after the productive symptomatology of affect (mania or depression).

As for memory, the very phenomenon of the productive symptomatology of this mental function is not outlined, since, based on theoretical premises, it should clinically manifest itself in the absence of consciousness (what happens with memory impairment, a person does not remember). In practice, however, the development of negative symptoms of the mental function "thinking" (epileptic dementia) is preceded by epileptic seizures.

Classification of mental disorders

There are three main classifications of mental disorders: the International Classification of Diseases (ICD; current - ICD-10, class V: mental and behavioral disorders), the American Diagnostic and Statistical Manual of Mental Disorders (DSM; current - DSM-5) and the Chinese Classification of Mental Disorders. disorders (CCMD; current - CCMD-3).

Below is the division of mental illness that has been used in practical psychiatry for the past hundred years. These diseases include, in particular, organic brain disease (more accurately called the psychoorganic syndrome), epilepsy, schizophrenia and bipolar affective disorder (a name that has become widespread recently; the former name is manic-depressive psychosis). In ICD-10, epilepsy (G40) belongs to class VI "Diseases of the nervous system (G00 - G99)". Previously considered as one of the typical "mental illnesses" (for example, K. Jaspers identified three typical "mental illnesses": epilepsy, manic-depressive psychosis and schizophrenia), epilepsy has long been removed from psychiatric classifications, and the concept of epilepsy was replaced by the concept of epileptic syndrome ...

Psychoorganic syndrome

Because the key point in dementia caused by psychoorganic syndrome is memory impairment, then intellectual disorders in patients are manifested first of all, the ability to acquire new knowledge deteriorates to varying degrees, the volume and quality of knowledge obtained in the past decreases, the range of interests is limited. In the future, the deterioration of speech is added, in particular oral (the vocabulary decreases, the structure of phrases is simplified, the patient often uses verbal templates, auxiliary words). It is important to note that memory impairments extend to all types of memory. The memorization of new facts worsens, that is, the memory for current events suffers, the ability to preserve the perceived and the ability to activate memory reserves decreases.

Epilepsy

The clinical manifestations of epilepsy are extremely diverse. In the 19th century, it was widely believed that this disorder was associated with an inevitable decline in intelligence. In the twentieth century, this concept underwent a revision: it was found that the deterioration of cognitive functions occurs only in relatively rare cases.

In cases where a characteristic epileptic defect (epileptic dementia - epileptic dementia) develops, its key component is impaired thinking... Cognitive operations include analysis, synthesis, comparison, generalization, abstraction and concretization with the subsequent formation of concepts. The patient loses the ability to separate the main, the essential from the secondary, from small details. The patient's thinking becomes more and more specific and descriptive, cause-and-effect relationships are no longer understandable for him. The patient gets bogged down in trifles, with great difficulty switches from one topic to another. In patients with epilepsy, it is found that the called objects are limited to the framework of one concept (only pets are called as animate or furniture and the environment as inanimate). The inertia of the course of associative processes characterizes their thinking as rigid, viscous. The depletion of vocabulary often leads to the fact that patients resort to the formation of an antonym by adding a particle "not" to a given word. The unproductive thinking of people with epilepsy is sometimes called labyrinthine.

Schizophrenia

This article deals only with the characteristic schizophrenic defect (schizophrenic dementia - dementia praecox). This dementia is characterized by emotional impoverishment, reaching the degree of emotional dullness. The defect is that the patient does not develop emotions at all and (or) the emotional reaction to the production of thinking is perverted (such a discrepancy between the content of thinking and emotional assessment is called "splitting of the psyche").

Currently, the opinion that schizophrenia inevitably leads to dementia is refuted by research - often the course of the disease is favorable, and with this course, patients have the opportunity to achieve long-term remission and functional recovery.

Bipolar disorder

With the development of mental disorders (productive symptoms, that is, mania or depression), a mental function called the "affect" of a defect (dementia) does not occur.

Unified psychosis theory

According to the theory of "unified psychosis", a single endogenous mental illness, which combines the concepts of "schizophrenia" and "manic-depressive psychosis", at the initial stages of its development proceeds in the form of "mania", "melancholy (that is, depression)" or " madness "(acute delirium). Then, in the case of the existence of "insanity", it is naturally transformed into "nonsense" (chronic delirium) and, finally, leads to the formation of "secondary dementia". The founder of the theory of a single psychosis is V. Grisinger. It is based on the clinical principle of T. Sydenham, according to which the syndrome is a natural combination of symptoms that change over time. One of the arguments in favor of this theory is the fact that affect disturbances include specific disturbances in thinking caused exclusively by disturbances in affect (the so-called secondary changes in thinking). Such specific (secondary) thinking disorders are, first of all, a violation of the rate of thinking (the rate of the thinking process). A manic state causes an acceleration of the pace of thinking, and depression slows down the pace of the thinking process. Moreover, changes in the pace of thinking can be so pronounced that thinking itself becomes unproductive. The pace of thinking in mania can increase to such an extent that any connection is lost, not only between sentences, but between words (this state is called "verbal okroshka"). On the other hand, depression can slow down the pace of the thinking process so much that thinking stops altogether.

Disturbances of affect can also become the cause of a kind, characteristic only of disturbances of affect, delusions (such delusions are called "secondary"). Manic states cause delusions of grandeur, and depression is the root cause of self-deprecating ideas. Another argument in favor of the theory of a single psychosis is the fact that there are intermediate, transitional forms between schizophrenia and manic-depressive psychosis. And not only from the point of view of productive, but also from the point of view of negative, that is, determining the diagnosis of the disease, symptoms. For such transient conditions, there is a general rule that says: the more in the endogenous disease disorder of affect in relation to productive disorder of thinking, the subsequent defect (specific dementia) will be less pronounced... Thus, schizophrenia and manic-depressive psychosis are one of the variants of the course of the same disease. Only schizophrenia is, according to the supporters of the theory of "single psychosis", the most malignant variant of the course, leading to the development of severe dementia, and manic-depressive psychosis is the most benign variant of the course of a single endogenous disease, since in this case the defect (specific dementia) is not develops in general.

Deinstitutionalization of psychiatry

Political use of psychiatry

The use of psychiatry for political purposes in the USSR

Antipsychiatry

Literature

• Workshop on Psychiatry: Textbook. allowance. Ed. prof. M.V. Korkina. 5th ed., Rev. - M .: RUDN, 2009 .-- 306 p. ISBN 978-5-209-03096-6
• Bukhanovsky A.O., Kutyavin Yu.A., Litvak M.E. General psychopathology. 3rd ed. M., 2003.
• Zharikov N.M., Ursova L.G., Khritinin D.F. Psychiatry: Textbook - M .: Medicine, 1989. - 496 p: ill. (Textbook. Literature. For student medical institute. San.-Gig. Fac.) - ISBN 5-225-00278-1
• Zharikov N.M., Tyulpin Yu. G. Psychiatry: Textbook. - M .: Medicine, 2000. ISBN 5-225-04189-2
• Kannabikh Yu. V. History of psychiatry. - M .: AST, Minsk: Harvest, 2002 .-- 560 p. ISBN 5-17-012871-1 (AST) ISBN 985-13-0873-0 (Harvest)
• Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry: Textbook. - M .: Medicine, 1995 .-- 608 p. ISBN 5-225-00856-9
• Korkina M.V., Lakosina N.D., Lichko A.E., Sergeev I.I. Psychiatry: Textbook. 3rd ed., Add. and revised - M., 2006.
• Psychiatric Guide. Ed. G.V. Morozov. In 2 volumes. - M., 1988.
• Psychiatric Guide. Ed. A. V. Snezhnevsky. In 2 volumes. - M., 1983.
• Psychiatric Guide. Ed. A.S. Tiganova. In 2 volumes. - M .: Medicine, 1999. ISBN 5-225-02676-1
• Handbook of Psychiatry. Ed. A. V. Snezhnevsky. - M .: Medicine, 1985

General psychiatry (psychopathology)

psychiatry behavioral paraclinical psychopharmacotherapy

Psychiatry as a Science

Psychiatry as a Science.

Psychiatry(from the Greek psyche - soul, iatreia - treatment) is a medical science that studies the issues of etiology, pathogenesis, clinic, treatment and prevention of mental illness. The term "psychiatry" was proposed by the German scientist J. Reil in 1803. Psychiatry is subdivided into general(psychopathology) and private.

Basic method psychiatry - clinical research. Modern psychiatry uses neurophysiological, biochemical, immunological, genetic, psychological, epidemiological, and other methods.

Tasks psychiatry are:

• - determination of objective patterns of mental disorders;
• - therapeutic measures, prognosis and prevention of mental illness;
• - the development of issues of the formation and development of individual psychopathological phenomena of mental illness in general in connection with the course of biological processes in the body and, in particular, the mechanisms of higher nervous activity (HND);
• - analysis of the occurrence and course of mental disorders in connection with the objective conditions of human life and activities, the development of a system of rehabilitation measures.

Independent sections of psychiatry are child psychiatry, old age psychiatry, forensic psychiatry.

Child psychiatry- the field of medicine, which develops theoretical problems and practical methods of diagnosis, clinic and correction of mental disorders in childhood. Conventionally, D. of the item is divided into three main directions - medical and pedagogical, psychological, and clinical and psychopathological.

Historical aspect of the development of child psychiatry

For about two hundred years, there has been an accumulation of facts, experience of observing children with mental disorders, behavioral and developmental disorders. Over the past 100 years, child psychiatry has taken shape as an independent science, and a child with mental disorders has ceased to be regarded as a small mentally ill adult.

From the second half of the 18th century. single descriptions of children with mental retardation began to appear.

First (empirical) period development of child psychiatry (late 18th - early 19th centuries), is based on the moralistic theory of describing psychoses, according to which only dementia is possible in childhood, but not insanity.

K. Carus in 1809 denied the presence of psychoses in children, B. Morel (1809-1872) believed that cases of mental illness are rare before adolescence. He suggested that hereditary degeneration, which intensified from generation to generation, was the cause of the insanity.

Second (phenomenological) period during the first two thirds of the XIX century. characterized by the accumulation of ideas about symptoms and syndromes, the description of casuistic cases of mental illness in children. J. Eskirol drew attention to cases of accelerated development of children at the beginning and unexpectedly rapid growth of the defect later. The works of K. Kalbaum and K. Hecker are devoted to the description of the catatonia of puberty and hebephrenia of adolescence.

X. Maudsley (1871) described movement disorders of the catatonic type, hallucinations of the imagination, delusional ideas. K. Vogt substantiated the dependence of the development of the brain on the severity of microcephaly. In the second half of the XIX century. the possibility of psychoses in children was proved, and a children's psychiatric department was opened in Paris.

The third (nosological) period (from the end of the 19th century) was distinguished by an active study of the etiopathogenesis, the clinical picture of mental illness in children and adolescents. End of the 19th century became a significant period in the history of child psychiatry. In 1867, X. Models suggested that age may play a significant role in the development of mental disorders, and proposed a classification of children's mental disorders.

Late 19th - early 20th century counts the beginning of modern child psychiatry, when manuals on mental disorders of childhood began to appear in France, England, Germany.

Throughout the XX century. child psychiatry has evolved towards reaching the level of evidence-based medicine. Psychological methods were created to assess the mental maturity and educational opportunities of children. The psychoanalytic direction of the development of psychiatry made it possible to draw attention to the mental trauma of childhood as a possible cause of mental disorders in the future. At the turn of the XIX and XX centuries. the study of juvenile delinquency began. In the 20s. XX century in America and England, psychiatric institutions were created - of an outpatient type, where complex teams consisting of a psychiatrist, psychologist and social worker worked with children. J. Bowlby (1907-1990) substantiated the dependence of mental disorders in children on the mother-child relationship, factors of maternal love deprivation. The development of the science of behavior (ethology) contributed to more active work with children to correct behavior. New clinical forms of neuropsychic disorders in children were identified (syndromes of childhood autism, hyperactivity, attention deficit, etc.). Modern classifications of mental and behavioral disorders, in comparison with pre-existing ones, include an increasing list of disorders observed in childhood.

Present period The development of child (and general) psychiatry over the past decades, as mentioned above, is characterized by a departure from the nosological principle as the only one, the predominance of an eclectic, pragmatic approach, which is reflected in the classification systems.

The first descriptions of mental illness in children in Russia appeared from the beginning of the 19th century. At the same time, in accordance with the global pattern, attention was mainly paid to mental retardation. The representative of psychiatrists of the Moscow school B. Kramer in 1819 in his work "On hard drinking and its treatment", calculated as "instruction to everyone", including "non-doctors", drew attention to the fact that in families of alcoholics and at a young age addiction to alcohol occurs faster. The first institution for the mentally retarded and epileptics with a therapeutic and pedagogical bias was opened by F. Platz in 1854 in Riga.

THEM. Balinsky, the founder of the first department of psychiatry in Russia (1857) at the Medical-Surgical Academy in St. Petersburg, studied oligophrenia, his successor I.P. Merzheevsky began researching the somatic origin of mental disorders. In 1882 the spouses Malyarevsky opened a medical and educational institution for mentally ill and abnormal children.

The formation of child psychiatry as an independent science dates back to the beginning of the 20th century, when in St. Petersburg in 1908 V.M. Bekhterev created a neuropsychiatric research institute with a children's department. The followers of V.M. Bekhterev, known for their work in the field of child psychiatry (R.Ya. Golant, S.S.Mnukhin, etc.). S.S. Mnukhin, in particular, studied the features of psychophysical dysontogenesis and, together with his student D.N. Isaev - mental retardation.

In Moscow in 1907, the prominent psychiatrist V.P. Kashchenko opened a boarding school for mentally retarded children. He also did a lot of work in the department of child psychopathology, organized in 1918 at the People's Commissariat of Health. In 1911, the Institute of Child Psychology and Neurology was established in Moscow, the founder of which was G.I. Rossolimo, who developed the "psychological profile" of the child.

One of the founders of defectology was A.S. Griboyedov, an epidemiological method for the study of mental illness in children and adolescents - E.A. Osipova. On her initiative, neuropsychiatric offices were created at general polyclinics, specialized kindergartens and orphanages.

Out-of-hospital care institutions for children and adolescents (mainly neuropsychiatric dispensaries) were supervised by three departments: health, education and social assistance. Scientific research in the field of child psychiatry in Russia began to develop especially intensively in the late 1920s. - the beginning of the 30s. XX century

G.E. Sukhareva, T.P. Simson, M.Sh. Vrono, V.N. Mamtseva, V.M. Bashina, A.E. Lichko, in the study of the characteristics of affective disorders in children, including the psychotic level - S.S. Mnukhin, N.M. Iovchuk, O.D. Sosyukalo and others.

Age features of childhood epilepsy, issues of etiology and pathogenesis, treatment were especially fruitfully studied in 1960-1980. XX century (S. S. Mnukhin, A. M. Korovin, G. G. Shanko and others).

Started by P.B. Gannushkin and O.V. Kerbikov's studies of behavioral disorders, character formation disorders, and peculiarities of neuroses in children and adolescents were continued by their students and followers (V.V. Kovalev, G.E. Ushakov, N.D. Lakosina, M.V. Korkina, A.E. Lichko, V.T.Kondratenko and others).

G.E. Sukharev, then V.V. Kovalev headed the Department of Child Psychiatry at the Moscow Institute for Advanced Medical Studies, carried out a lot of work on training personnel for child psychiatry, improving child psychiatric care.

In recent years, the Department of Child Psychiatry and Psychotherapy of the Russian Academy of Postgraduate Education has been headed by student V.V. Kovaleva - Yu.S. Shevchenko, who made a significant contribution to the development of the study of borderline mental pathology in childhood and adolescence and the expansion of the network of psychotherapeutic assistance to children and adolescents.

Currently, special attention should be paid to the problem of dependence on psychoactive substances in children and adolescents (I.N. Pyatnitskaya, A.E. Lichko, P.I.Sidorov, BC Bitensky, etc.), psychosomatic disorders (D.N. B.E. Mikirtumov, Yu.F. Antropov, Yu.S. Shevchenko, A.A. Kozlova, N.V. Rimashevskaya, G.V. Kozlovskaya and others).

Diagram of the organization of psychiatric care.

/. Outpatient (community) care.

• 1. Psychiatric (neuropsychiatric) office of a children's or general polyclinic with a district (district) psychiatrist (child or general), a psychiatric office of the Central District Hospital.
• 2. A neuropsychiatric dispensary or a dispensary department at a psychiatric hospital of a city, region, republic - a general one, which has in its structure children's, adolescent psychiatric and speech therapy rooms, or a children's one, which may include district child psychiatrists and consulting rooms (speech therapist, etc.). ).
• 3. Narcological dispensary.

II. Inpatient psychiatric care.

• 1. Psychiatric hospitals (city and regional) in the health care system, which include various specialized departments (male and female, narcological, infectious, tuberculosis, forensic psychiatric, etc.), including children's and adolescent departments.
• 2. Specialized psychiatric hospitals in the system of the Ministry of Internal Affairs (for compulsory treatment of especially dangerous mentally ill who have committed illegal actions).
• 3. Narcological hospitals.
• 4. Psychoneurological departments at neuropsychiatric dispensaries, large somatic hospitals and military hospitals (for the treatment of patients with acute short-term psychoses, neuroses and reactive states, residual phenomena of organic brain lesions with mental disorders, etc.).
• 5. Day and night hospitals (at psychiatric hospitals or neuropsychiatric dispensaries) for the aftercare of recovering mentally ill and for anti-relapse supportive treatment of patients under the supervision of neuropsychiatric offices and dispensaries.
• 6. Psychoneurological sanatoriums (for adults and children).
• 7. Houses for disabled persons-psychochronic (adults and children).

III. Social rehabilitation institutions.

• 1. Treatment and labor workshops (LTM) at psychiatric hospitals and dispensaries.
• 2. Subsidiary farms at psychiatric hospitals, rehabilitation centers.
• 3. Sanatorium schools (for children with asthenic conditions).
• 4. Schools and groups for children with speech and other disabilities.
• 5. Boarding schools and schools for mentally retarded children.

In the early identification of adults and children in need of psychiatric supervision and treatment, a significant role is played by family doctors, district therapists and pediatricians, who, due to the nature of their work, are usually the first to encounter various mental disorders in patients during outpatient, preventive and other examinations.

Features of mental disorders in childhood.

Disorder of mental development- a universal form of children's reaction to any external negative impact and, in a broad sense, reflecting changes in the psyche as a relationship between social and biological. The course, outcome and prognosis of mental illness in children and adolescents, in comparison with adults, have their own characteristics (A.I. Seletsky). This explains the importance of the fact that in the study of mental disorders in children, it is necessary to adhere to the ontogenetic approach. This was pointed out by such researchers as: M.S. Zelensky, V.A. Murashov, as well as M.O. Gurevich, G.E. Sukhareva, G.K. Ushakov, V.V. Kovalev, K.S. Lebedinskaya, A.I. Lichko and others.

According to V.V. Kovalev, dysontogenesis is expressed in various violations of the rate, timing of the development of the psyche as a whole and its individual components, as well as in the violation of the ratio of the components of the developing psyche of a child and adolescent. The causes of mental dysontogenesis are biological (genetic, etc.) pathogenic factors, as well as unfavorable social and environmental influences. The main mechanisms mental dysontogenesis, according to many authors, are retardation and asynchrony(V.V. Kovalev, G.E. Sukhareva, G.K. Ushakov). Along with the indicated mechanisms of impaired mental development, mainly in child psychiatry, also regression and acceleration.

Based on the biogenetic theory of the stages of development, V.V. Kovalev suggested that the pathogenetic basis of manifestations of mental disorders in childhood and adolescence is qualitatively different levels of pathological neuropsychic response, which naturally replace each other:

• 1. Somato-vegetative level(0-3 years old). This level is characterized by various variants of neurasthenic syndrome: increased general and nervous excitability, a tendency to digestive disorders, eating disorders, sleep disorders, disorders of neatness skills.
• 2. Psychomotor level(4-7 years old). It includes hyperactivity syndrome, systemic neurasthenic and neurosis-like movement disorders; also stuttering, mutism.
• 3. Affective(5-10 years old). It is characterized by a syndrome of fears, increased affective excitability.
• 4. Emotional and ideational(11-17 years old). This level is characterized by disorders based on overvalued formations (overvalued hypochondriac syndrome, syndromes of dysmorphophobia, anorexia nervosa, metaphysical intoxication syndrome), as well as pathological reactions of puberty (protest, emancipation, etc.).

V.V. Kovalev emphasizes that the symptomatology inherent in each level of neuropsychic response does not exclude the manifestations of the previous levels, but pushes them into the background and modifies them.

The connection between child psychiatry and special pedagogy and psychology.

Currently, for various reasons, the number of children with developmental disabilities is increasing. This is facilitated by the destabilization of society as a whole and individual families, the absence in some cases of normal economic and environmental conditions, the shortcomings of school and family education, cognitive deprivation, insufficient satisfaction of sensory and emotional contacts and needs. These and many other pathological factors lead to various diseases and developmental disabilities.

The issue of developmental disabilities can only be considered in the context of knowledge about the normal parameters of the personality. One of the main meanings of the term "norm" is an established measure, the average value of something. The concept of a norm is relatively constant. Its content largely depends on the level of culture of a given society and changes significantly over time. The problem of criteria for the norm, normal human development becomes relevant in the context of corrective-developmental activity, solving problems of education and upbringing, preventing more severe developmental disorders.

The peculiarities of the corrective influence on the child depend on the nature of the disorder he has, the severity of deviations of certain mental processes and functions, on the age and compensatory capabilities of the child, on the nature of the medical and pedagogical influence, on the living and upbringing conditions. There is a need for early diagnosis and early qualification of the disorder, which will provide an adequate therapeutic and recreational and correctional pedagogical impact.

the field of medicine that studies the causes of mental illness, their manifestations, methods of treatment and prevention. The main method of psychiatry is clinical examination using neurophysiological, biochemical, immunological, genetic and psychological methods. Highlighted:

1) general psychiatry (or general psychopathology) - which examines the patterns of violations of mental activity;

2) private psychiatry - which deals with mental diseases, primarily psychopathies, neuroses, reactive states.

PSYCHIATRY

psycho + Greek. iatreia - healing, treatment). A clinical discipline that studies the etiology, pathogenesis, clinic, the prevalence of mental diseases, develops methods for their clinical and laboratory diagnostics, issues of diagnosis, prognosis, prevention, examination criteria, the procedure for social and labor rehabilitation. In P., such sections are distinguished as P. organizational, "age (children, adolescent, gerontological), military, rehabilitation, social (studies the role of social factors in the origin of mental illness and in carrying out rehabilitation work), judicial, endocrinological.

Psychiatry

Word formation. Comes from the Greek. psyche - soul and iatreia - treatment.

Specificity. Studies the causes of mental illness, their manifestations, methods of treatment and prevention.

Method. The main method of psychiatry is clinical examination using neurophysiological, biochemical, immunological, genetic, psychological methods.

Views. There are general psychiatry, or general psychopathology, which studies the patterns of mental disorders, and private psychiatry, which deals with mental illnesses, primarily psychopathies, neuroses, and reactive states.

PSYCHIATRY

Medical specialization focusing on the prevention, diagnosis, treatment and research of mental disorders. Psychiatry, while parallel in many respects to clinical psychology, has historically and nowadays been more of a branch of medicine, with psychiatrists holding a MD, while clinical psychologists have a PhD or other professional degree. The historical issue is more important here than many might think, since psychiatry has traditionally held the view that emotional and behavioral disorders are medical problems and that a person with severe behavioral or emotional dysfunction is mentally ill; for more terminology see Medical Model and Mental Illness. Thus, the psychiatrist is trained mainly in the framework of pathology, its prevention and treatment, and receives little knowledge in the field of theories of normal behavior, planning and preparation of experiments, collecting and analyzing data, etc. The practice of psychiatry is extremely voluminous and includes aspects that are truly purely medical, such as drug treatment, electroshock therapy, legal issues of hospitalization and organic dysfunctions with psychological manifestations. However, it also includes many aspects that have little to do with medicine in the strict sense, including behavior change therapy, psychoanalysis, etc. Indeed, in these areas, the practicing psychiatrist differs little from the practicing clinical psychologist.

For various reasons, even a healthy person can experience a mental disorder, which is also often called mental. The clinical branch that studies them is called psychiatry. Specialists in this area know best of all how severe emotional disorders are treated, as well as what methods of their prevention exist. Psychiatrists provide their assistance to mentally ill people. Patients with a severe mental disorder and unhealthy behavior that pose a potential threat to themselves and the surrounding population, specialists have the right to isolate.

History of psychiatry

The path of development of psychiatry was very long and confusing. With the change of generations of scientists, the complete understanding of the subject of study and the actual goals changed.

• The oldest society was very religious and believed in mysticism, which is why they associated mental disorders in people with the possession of evil spirits, with a curse or the activity of dark forces. Any insanity was already associated with the brain, for which a craniotomy was performed, a procedure supposedly "freeing" the spirits from the patient's head.
• The end of the nineteenth century becomes very busy in terms of psychiatric research. During this period, two completely opposite theories appeared, which were put forward by Sigmund Freud and Emil Kraepelin.

The first of them, together with his like-minded people, singled out something that he called "the unconscious." In his understanding, this meant that in the consciousness of any person there are own natural instincts, which are always in our head (for the most part, they have an erotic connotation). But the imposed norms of morality in society oppress these "desires", because of which there is an internal confrontation. When instincts win, then the forbidden appears outside, which is very painful for the person himself. Hence the psychiatric disorder.

E. Crepelin found paralysis in this mental disorder, which leads to the destruction of brain tissue, which in turn is expressed by a number of symptoms.

But, due to the constant disputes between opponents and the presence of some gaps, all this remained at the theoretical level, although it still has a few followers.

• A way out of the resulting impasse was found by E. Husserl, who laid the foundation for phenomenological psychiatry. It is based on a certain "phenomenon" that serves as an integral part of the mind of a healthy person. If a conflict develops between them, then this leads to a mental disorder.
• K. Jaspers continued this teaching and introduced the method of interviewing the patient, in order to identify his own subconscious phenomena and their classification, for the correct diagnosis. Further, J. Minkowski and G. Ellenberg developed a special approach in the treatment of mental disorders, which is used in modern psychiatry.

Sections of psychiatry

Mental disorders can be very different in their severity and severity of consequences. Therefore, psychiatry is usually divided into 2 sections:

1. General psychiatry. It studies the main mental illnesses, their properties, causes of development and patterns, the classification of disorders, as well as research and therapeutic activities in relation to them. Particular attention is paid to the general signs that are inherent in common mental illness: hallucinations, illusions and thinking disorders.
2. Private psychiatry. Her interests include specific mental illnesses, their etiology and pathogenesis, clinical manifestations, methods of treatment and recovery. What kind of diseases she studies, you will learn a little later.

Features of diagnostics in psychiatry

Despite the technical and laboratory research methods that scientists have brought to the perfect level, their significance in psychiatry is not very great.

As an aid for the examination of cerebral activity, they are used:

• Electroencephalography;
• X-ray;
• Computed tomography;
• Magnetic resonance imaging;
• Rheoencephalography;
• Doppler ultrasonography;
• Lab tests.

But specialists obtain the main diagnostic data from the clinical method, which is based on interviewing the subject and observing him and his mental state. The professional pays very special attention to the patient's facial expressions and intonation, their changes during a conversation on certain topics and other external reactions.

In parallel with this, a conversation is also conducted with relatives, who sometimes help to clarify a more complete picture of the patient's condition.

Modern psychiatry

The main methods of treatment used in modern psychiatry are based on the use of pharmacological drugs of the appropriate action. But more and more experienced professionals resort to psychotherapeutic methods that are more effective.

Mental illness

There is no age limit for mental disorders. People can face a "mental problem" both at a young age and at a more advanced age. All the fault may be heredity, living environment, living conditions, alcoholism, infections, diseases, trauma, intrauterine growth disorders (due to drunkenness of the parents, especially the mother during pregnancy, as well as diseases during her).

However, one should not perceive psychiatry, as it was previously characterized, like prison, bullying and torture. Nowadays, patients can undergo outpatient treatment, which is no less effective and humane.

Some of the most famous mental illnesses in humans are:

More about psychiatry